REPORT ON CHLOROFORM. 
103 
finds its way through the larynx, it is readily expelled by coughing. In operations upon 
the soft palate, fauces, pharynx, and posterior nares, if sudden or severe haemorrhage is 
likely to occur, it is not advisable to induce deep insensibility. 
In cases requiring laryngotomy and tracheotomy the anaesthetic may be employed with 
safety and advantage. 
For operations upon the eye, involving the contents of the globe, the use of anaesthe¬ 
tics is open to objection on account of the damage which the eye may sustain from mus¬ 
cular straining or vomiting. If employed, profound insensibility should be induced. 
In operations for hernia, and in the application of the taxis, the anaesthetic acts most 
beneficially. For most operations about the anus profound anaethesia is positively de¬ 
manded. 
In the condition of shock, or of great depression, as after haemorrhage, careful admi¬ 
nistration of the anaesthetic diminishes the risk of an operation. 
In all cases other than those specially referred to, it is sufficient to state, so far as a 
mere surgical operation is concerned, that an anaesthetic may invariably be administered. 
The continuous vomiting occasionally induced by, and following upon, the inhalation 
of anaesthetics, may be injurious by consequent exhaustion, as well as by mechanically 
disturbing the repair of a wound. With this reservation, they do not appear to interfere 
with the recovery of patients from surgical operations. 
Statistics. —The results of 2586 capital operations performed before, and of 1860 per¬ 
formed since, the introduction of anaesthetics, collected from all authentic available sources,* 
prove that anaesthetics have in no degree increased the rate of mortality. 
Use of Chloroform in Obstetric Practice . 
(a) In natural labour. —The careful administration of chloroform during labour is not 
attended with special danger, there being, either in this country or abroad, so far as is- 
known to this committee, no well-authenticated instance of sudden death where it has 
been given by a medical practitioner; but the occasional occurrence of unfavourable 
symptoms demands the exercise of caution during its employment. Administered in a 
moderate degree, it does not, as a rule, weaken the expulsive powers, and is decidedly 
beneficial in promoting dilatation of the maternal passages. It does not predispose to 
puerperal convulsions or other like complications. The balance of opinion is nearly 
equal as to whether it predisposes to imperfect contraction of the uterus after delivery. 
As a rule, it in no way retards the convalescence of the mother; nor has it any tendency 
to interfere injuriously with the function of lactation ; nor has it any injurious influence 
on the child. 
( [b ) In abnormal labour. —The anaesthetic may be employed with advantage in various 
obstetrical operations—as forceps, turning, craniotomy, and extraction of retained pla¬ 
centa,—unless the patient is much enfeebled by haemorrhage; when, if given, it ought 
to be accompanied by the use of stimulants. It may also be employed advantageously 
to check the paroxysms in puerperal convulsions. 
(c) As to the preference of JEther. Rules relating to the administration of chloroform .— 
There are no reasons for giving preference to ether over chloroform, the latter being 
much more desirable in obstetrical practice generally, the only exceptions being those 
in which chloroform notably disagrees. 
In addition to those given for its administration in ordinary cases, it is generally desi¬ 
rable to observe the following rules during its administration in labour, subject to modi¬ 
fications at the discretion of the practitioner:—In natural labour, begin to give it gene¬ 
rally at or after the termination of the first stage ; but it may be given earlier if the first 
stage is unduly painful, or if the os uteri resists dilatation. Give it only during the 
pains, and withdraw it in the intervals. When the foetal head bears on the perineum, 
give it more freely, to promote relaxation and relieve the increased pain. Withdraw the 
chloroform immediately after the child is expelled. If the patient is depressed or the 
pains are sluggish during its administration, an occasional stimulant may be administered. 
In cases where it seems to interfere with the progress of labour it may be necessary to 
suspend its use for a time, and reapply it after an interval, or even to withdraw it alto¬ 
gether. In turning and instrumental deliveries deep anaesthesia must be induced, as in 
surgical operations, and the administration should then be entrusted to a competent per¬ 
son, whose sole duty should be to attend to it. In midwifery a special inhaler for its ad- 
* Appendix D to the Report, p. 149. 
